Abstract
BackgroundGain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. We have previously shown in CR, that gain in VO2 peak is reduced in Type 2 diabetic patients and that response to CR is impaired by hyperglycemia.MethodsWe set up a prospective multicenter study (DARE) whose primary objective was to determine whether good glycemic control during CR may improve the gain in VO2 peak. Sixty four type 2 diabetic patients, referred to CR after a recent ACS, were randomized to insulin intensive therapy or a control group with continuation of the pre-CR antidiabetic treatment. The primary objective was to study the effect of glycemic control during CR on the improvement of peak VO2 by comparing first the 2 treatment groups (insulin intensive vs. control) and second, 2 pre-specified glycemic control groups according to the final fructosamine level (below and above the median).ResultsAt the end of the CR program, the gain in VO2 peak and the final fructosamine level (assessing glycemic level during CR) were not different between the 2 treatment groups. However, patients who had final fructosamine level below the median value, assessing good glycemic control during CR, showed significantly higher gain in VO2 peak (3.5 ± 2.4 vs. 1.7 ± 2.4 ml/kg/min,p = 0.014) and ventilatory threshold (2.7 ± 2.5 vs. 1.2 ± 1.9 ml/kg/min,p = 0.04) and a higher proportion of good CR-responders (relative gain in VO2 peak ≥ 16 %): 66 % vs. 36 %, p = 0.011. In multivariate analysis, gain in VO2 peak was associated with final fructosamine level (p = 0.010) but not with age, gender, duration of diabetes, type of ACS, insulin treatment or basal fructosamine.ConclusionsThe DARE study shows that, in type 2 diabetes, good glycemic control during CR is an independent factor associated with gain in VO2 peak. This emphasizes the need for good glycemic control in CR for type 2 diabetic patients.Trial registrationTrial registered as NCT00354237 (19 July 2006).
Highlights
Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity
No significant differences were seen between the 2 groups for gender, age, diabetes duration, history of previous Coronary Heart Disease (CHD), tobacco smoking, BMI, type of ACS, resting heart rate, Table 1 Baseline characteristics
Results of CR according to the glucose control during CR To analyse the effect of glycemic control during CR on the results of CR, we compared the data between two pre-specified groups according to the final fructosamine level
Summary
Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. Several studies have clearly shown that cardiac rehabilitation (CR) significantly reduces cardiovascular morbidity and mortality and improves quality of life. One of the results of CR is to improve exercise capacity (assessed on peak oxygen uptake [peak VO2]), in patients with established coronary heart disease. It has been reported, based on a long-term prognosis study in 12 169 men in CR, that exercise capacity, determined by direct measurement of peak VO2, exerts a major long-term influence on prognosis in patients after Myocardial Infarction (MI) or ischaemic heart disease, with a 9 % improvement in prognosis for 1-ml/kg/mn increment in peak VO2 [17]. Vanhees et al have demonstrated that peak VO2 improvement after CR reduced significantly cardiovascular morbidity and mortality in coronary patients [18]. All these data indicate that a part of the benefit of CR on cardiovascular morbidity and mortality is related to VO2 improvement
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